Epidural neuroplasty against fibrous mass formation during long-term use of epidural route: case report
G. K. Talu1, S. Erdine2
1Istanbul University Istanbul Faculty of Medicine, Department of Algology, M. D.
2Istanbul University Istanbul Faculty of Medicine, Department of Algology, M. D., Prof.
Keywords: Epidural neuroplasty, fibrosis, complications of drug delivery systems
Abstract
Epidural application of drugs is still the choice of treatment in selected patients. However, the fibrosis developing around the catheter is a frequent and disabling problem. Inspiring from the idea of neuroplasty against fibrous tissue formation in failed back surgery syndrome, we aimed to relieve injection related burning pain due to fibrosis, by administering hypertonic saline and steroids. Three cases; two cancer patients and one non-cancer patient had epidural port implantation for long-term drug delivery. However the patients had epidural fibrosis and injection related pain after a while. After hospitalisation, epidural neuroplasty with 5 ml of bupivacaine 0.5 %, 4 ml of hypertonic saline and 40 mg of methylprednisolone was applied to breakdown the scar tissue. In all cases injection related pain was treated. The procedure was repeated successfully in two cases due to the reoccurrence of pain during their follow up. We have concluded that either cancer or non-cancer pain, when fibrosis and injection related pain develops due to use of epidural route, epidural neuroplasty can be used safely and effectively.